Background. It is well known that socioeconomic indicators, such as income and education, predict both stroke incidence and stroke mortality. This means that persons in lower socioeconomic positions are less likely to survive their stroke, and there will be a selective survival in the group discharged from hospital after their first stroke. Question. Does socioeconomic position continue to predict mortality, stroke specific, or from other causes, among patients surviving their first stroke in spite of this selective survival? Methods. All persons in Sweden aged 40–59 years who were discharged after a first hospitalization for stroke in 1996–2000 were included (n = 10,487), then followed up until the end of the fourth calendar year after discharge. Data were analysed with Cox regressions controlling for age, sex, and stroke type. Results. Persons with high socioeconomic position, measured by education and income, have lower mortality than those of low position. Education was not significant when adjusted for income, however. The risk of dying was similar for stroke-specific mortality and all-cause mortality, for those with cerebral infarction as well as for all patients. Conclusions. Socioeconomic position predicted stroke-specific mortality also in the selective group of persons who survived their first stroke.

Venepuncture and the insertion of peripheral venous catheters are common tasks in health care, and training in these procedures is included in nursing programmes. Evidence of nursing students’ knowledge and skills in these procedures is limited. The main aim of this study was to assess nursing students’ knowledge and skills when performing venepuncture and inserting peripheral venous catheters. Potential associations between level of knowledge and skills, self-training, self-efficacy, and demographic characteristics were also investigated. The assessment was performed by lecturers at a university college in Sweden using the two previously tested instruments "Assess Venepuncture"€ and "Assess Peripheral Venous Catheter Insertion". Between 81% and 100% of steps were carried out correctly by the students. The step with the highest rating was "€œUses gloves", and lowest rating was "€˜Informs the patients about the possibility of obtaining local anaesthesia"€™. Significant correlations between degree of self-training and correct performance were found in the group of students who registered their self-training. No associations between demographic characteristics and correct performances were found. Assessing that students have achieved adequate levels of knowledge and skills in these procedures at different levels of the nursing education is of importance to prevent complications and support patient safety.

Objectives: To evaluate changes in meal patterns and in obesity related risk factors after 1 year of treatment in obese men. Design: Data from two 24-h dietary recalls, performed at base-line and after 1 year of treatment, were related to changes in medical risk factors. Setting: Academic obesity unit. Subjects: Sixty-three men, aged 44 (eight) years (mean [SD]) and Base- line Body Mass Index (BMI) 37.4 (4.6) kg m^-2, who had completed 1 year of treatment. The men were subdivided by tertiles according to weight change: tertile I (n = 21), mean +0.3 kg, tertile II (n = 21), mean -5.8 kg and tertile III (n = 21), mean -14.2 kg. Main outcome measures: Weight loss, changes in meal patterns and in obesity related medical risk factors. Results: The reported mean energy intake decreased after treatment in tertiles II and III by 700 (1300) kcal (P < 0.05) and 700 (900) kcal (P = 0.001), respectively. In tertile III the energy-% from fat decreased (P < 0.05) with a reciprocal increase in energy-% from protein (P < 0.05). The frequency of snacks of a low nutritional quality decreased (P < 0.01) in tertile III together with an increase in energy-% from 'hot meals of good quality' (P < 0.05). Obesity related risk factors (anthropometry, blood pressure, serum lipid concentrations, blood glucose and plasma insulin) improved in a beneficial way only in tertile III. Conclusions: The weight loss in the successful tertile III men was to a great extent explained by fewer low quality snacks but more energy from high quality meals. These changes reflected the behaviour modification strategy recommended.

Abstract:

Background: There has been a significant increase in the use of stimulants medication in used for Attention Deficit Hyperactivity Disorder (ADHD). The impairment could cause symptoms such as attention deficit, overactivity, impulsivity and lack of impulse control. These symptoms could contribute to significant difficulties in everyday life. Aim: The purpose was to describe how adults with ADHD experience their daily lives. Method: A descriptive literature study based on nine scientific articles. Main results: All participants described perceived symptoms as hyperactivity, impulsivity, inattention, oblivion, and the feeling of being disorganized. The symptoms affected the participant negatively in several areas of their life, such as the difficulty of starting and completing something but also maintaining a relationship. Most of the participants chose to medicate to get help with the symptoms but also needed to use strategies to help in everyday life. Some participants also described a need to self-medicate with alcohol and drugs. Conclusion: For people with ADHD, the experience of their disability is individual and needs to be addressed properly, that is, to meet them at their own level. When the healthcare system does not live up to this, the person is negatively affected. Society needs more knowledge and information so that all people, whether you have ADHD or not, can feel involved in the community. A higher knowledge would lead to less suffering, a greater understanding of how people with ADHD acts, improved nursing care and feeling of better involvement in their own care.

The aim of this study is to investigate how older adults were affected by the COVID-19 restrictions that were put in place by the Swedish Health Authority during the first wave of the COVID-19 pandemic to protect them and the roles played by social workers during the pandemic. A qualitative study was conducted whereby two older adults aged seventy and two practising professional workers were interviewed, and their responses analyzed using thematic analysis. The results showed that one of the older adults felt isolated, while the other did not have the same experience. The social workers on the other hand felt that they were responsible for the lives of their clients as well as that of their staff.

Bakgrund: Omkring 100 000 svenskar beräknas lida av bensår vilka kräver långa behandlingstider och medför ekonomiska kostnader för samhället. Olika sjukdomstillstånd såsom trauma och försämrad blodcirkulation anses som riskfaktorer. Att leva med bensår kan ha negativ inverkan på människors dagliga liv. Det är viktigt för sjuksköterskor att informera patienterna kring behandlingen, ge stöd samt ha förmågan att bemöta dem med respekt och empati. Syfte: Syftet med föreliggande studie var att beskriva hur patienter med bensår upplever sin livskvalitet samt att beskriva undersökningsgrupperna som ingick i de inkluderade artiklarna. Metod: Beskrivande litteratur studie som inkluderade tolv vetenskapliga artiklar som söktes fram i databasen Cinahl. Huvudresultat: Patienterna beskrev smärta som påverkade deras dagliga liv både fysiskt och psykiskt. Sömnproblem påverkade det psykiska måendet negativt. Rädslan för att skada sig begränsade patienterna fysiskt och man beskrev även känslan av skam, missmod, ensamhet, oro, ångest, depression och förlust av hopp. Bensår upplevdes tidssamt energikrävande och brister i kunskap hos sjukvårdpersonalen hade negativ påverkan på patienternas livskvalité. Undersökningsgrupperna varierade i antal från 5 till 247 deltagare, majoriteten var kvinnor, åldern var mellan 18 till 99 år. De flesta deltagarna hade haft venösa bensår, vilka varade mellan 6 veckor till 43 år. Slutsats: Att leva med bensår påverkade livskvaliteten. Relationen mellan sjuksköterska – patient hade stort betydelse för sårläkningen och välbefinnande. Det är viktigt att sjuksköterskor har tillräcklig kunskap om denna patientgrupp samt att ge ett professionellt bemötande, stöd och information om en egenvård. 

The study assesses exploratory the geography of the elderly fall in Sweden in relation to the ecology of the socio-demographic characteristics of the Swedes older population. Kendall Test is used to measure the association between elderly fall rates and demographic, socio-economic characteristics of the population, costs of elderly care and accessibility measures at county level. Results show a number of significant associations: high rates of the elderly fall are associated with high cost of the elderly care but also low rate of elderly fall and good accessibility to basic services (e.g., grocery store, health care and cash machines). The articles finalizes with reflections of the results and suggestions for future research.

BACKGROUND: Young adults with mobility disability (MD) are less likely to engage in regular physical activity (PA) compared with their able-bodied peers and inactive adults with a MD are more likely to report one or more chronic diseases compared to those who are physically active. Despite the vast amount of research published in the field of PA interventions over the past decades, little attention has been focused on interventions aiming to increase PA among individuals with MD. Thus, we propose to compare the effects of an eHealth program compared to a usual care supervised health program on levels of PA and other health behaviors.

METHODS: The current intervention will use a randomized controlled trial (RCT) design with two treatment groups (an eHealth program and a usual care supervised health program) in young adults with newly acquired MD. In total, 110 young adults (aged 18-40 years) with a MD, acquired within the past 3 years, will be recruited to participate in a 12-week intervention. The primary study outcome is accelerometer-measured time spent in moderate to vigorous PA. Secondary outcomes includes health-related quality of life, depression, stress, fitness, body composition, diet, musculoskeletal pain, motivation to exercise and work ability.

DISCUSSION: There is a lack of RCTs investigating effective ways to increase levels of PA in young adults with MD. Increased levels of PA among this physically inactive population have the potential to substantially improve health-related outcomes, possibly more so than in the general population. The trial will put strong emphasis on optimizing exercise adherence and investigating feasibility in the two treatment programs. The Ethical Review Board (EPN) at Karolinska Institutet has approved the study (2017/1206-31/1).

TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number (ISRCTN), reference number ISRCTN22387524 . Prospectively registered February 4, 2018.

Background

People with dementia and their informal carers often do not receive appropriate professional support or it is not received at the right time.

Objectives

Description and comparison of common pathways to formal community dementia care in eight European countries as a part of the transnational Actifcare project.

Materials and methods

The German team was responsible for creating an individual case scenario as a starting point. The research teams in Ireland, Italy, the Netherlands, Norway, Portugal, Sweden, and the United Kingdom were then asked to describe a common pathway to formal dementia care by writing their own vignette using the provided individual case scenario.

Results

A transnational qualitative content analysis was used to identify the following categories as being the most important: involved professionals, dementia-specific and team-based approaches, proactive roles, and financial aspects. General practitioners (GPs) are described as being the most important profession supporting the access to formal care in all the involved countries. In some countries other professionals take over responsibility for the access procedure. Dementia-specific approaches are rarely part of standard care; team-based approaches have differing significances in each of the countries. Informal carers are mainly proactive in seeking formal care. The Nordic countries demonstrate how financial support enhances access to the professional system.

Conclusion

Enhanced cooperation between GPs and other professions might optimize access to formal dementia care. Team-based approaches focusing on dementia care should be developed further. Informal carers should be supported and relieved in their role. Financial barriers remain which should be further investigated and reduced.

OBJECTIVE: The aim of this study was to investigate levels of perceived family cohesion during childhood, teenage years, and young adulthood in cancer-bereaved youths compared with non-bereaved peers.

METHODS: In this nationwide, population-based study, 622 (73%) young adults (aged 18-26) who had lost a parent to cancer 6 to 9 years previously, when they were teenagers (aged 13-16), and 330 (78%) non-bereaved peers from a matched random sample answered a study-specific questionnaire. Associations were assessed using multivariable logistic regression.

RESULTS: Compared with non-bereaved youths, the cancer-bereaved participants were more likely to report poor family cohesion during teenage years (odds ratio [OR] 1.6, 95% CI, 1.0-2.4, and 2.3, 95% CI, 1.5-3.5, for paternally and maternally bereaved youths, respectively). This was also seen in young adulthood among maternally bereaved participants (OR 2.5; 95% CI, 1.6-4.1), while there was no difference between paternally bereaved and non-bereaved youths. After controlling for a number of covariates (eg, year of birth, number of siblings, and depression), the adjusted ORs for poor family cohesion remained statistically significant. In a further analysis stratified for gender, this difference in perceived poor family cohesion was only noted in females.

CONCLUSION: Teenage loss of a parent to cancer was associated with perceived poor family cohesion during teenage years. This was also noted in young adulthood among the maternally bereaved. Females were more likely to report poor family cohesion. Our results indicate a need for increased awareness of family cohesion in bereaved-to-be families with teenage offspring, with special attention to gender roles.

Purpose: Our aim was to describe Swedish Healthcare Direct (SHD) and its features as a complex system.

Methods: Qualitative interviews were conducted with 20 SHD telenurses, covering their experiences and skills when encountering and advising callers with mental illness. Complexity science was used as an a priori theoretical framework to enhance understanding of the complex nature of telenursing.

Results: SHD was described as a complex system as nurses were constantly interacting with other agents and agencies. During these interactions, dynamic processes were found between the agents in which the nurses adapted to every new situation. They were constantly aware of their impact on the care-seekers, and perceived their encounters with callers with psychiatric illness as "balancing on a thin line". SHD was also described as both an authority and a dumping ground. The openness of the system did not give the nurses possibility to control the number of incoming calls and the callers' intentions.

Conclusions: These new insights into SHD have important implications for organization developers and nursing management in terms of overcoming linear thinking.

The aim of the study was to describe the telephone nurses' experiences of encountering callers with mental illnesses. Telenursing services are solely staffed with telenurses, who with the support of a decision support system (CDSS) independently triage callers based on the severity of the main symptoms presented by the care seeker. The system focuses on somatic symptoms, while information regarding mental health and mental illnesses is limited. Information about telenurses' experiences of encountering care seekers with mental illnesses is scarce, despite the increase in mental illnesses in the population. The study used a descriptive design with a qualitative approach. Twenty telenurses were interviewed, and the data were then analysed using inductive qualitative content analysis. The results are elaborated in the following three categories: (i) Experiences of encountering care seekers with mental illnesses; (ii) Experiences of facing difficulties and challenges; and (iii) Experiences of facing dissatisfaction and threats. Encountering care seekers with mental illnesses is metaphorically addressed as 'when all other doors are closed'. Encountering care seekers with mental illnesses was perceived as time-consuming and did not adequately correspond to the resources given by the service. Even though telenurses strive to achieve agreement, there is a collision between human needs and organizational structures. The study pinpoints the lack of resources for and education about mental illnesses and the limitations of the decision system, which needs to be updated in order to provide all care seekers care on equal terms.

For adolescent people with ID, falls are more common compared to peers without ID. However, postural balance among this group is not thoroughly investigated. The aim of this study was to compare balance and muscle performance among adolescents aged between 16 and 20 years with a mild to moderate intellectual disability (ID) to age-matched adolescents without ID. A secondary purpose was to investigate the influence of vision, strength, height and Body Mass Index (BMI) on balance. A group of 100 adolescents with ID and a control group of 155 adolescents without ID were investigated with five balance tests and three strength tests: timed up and go test, one leg stance, dynamic one leg stance, modified functional reach test, force platform test, counter movement jump, sit-ups, and Biering-Sørensen trunk extensor endurance test. The results showed that adolescents with an ID in general had significantly lower scores in the balance and muscle performance tests. The group with ID did not have a more visually dominated postural control compared to the group without ID. Height, BMI or muscle performance had no strong correlations with balance performance. It appears as if measures to improve balance and strength are required already at a young age for people with an ID.

This study tests the concurrent validity and test–retest reliability of a new functional balance test – the Dynamic One Leg Stance (DOLS) in blind subjects and sighted, blindfolded subjects. Twelve blind and 12 sighted men and women between 19 and 61 years volunteered to participate. The correlation between DOLS and the commonly used One Leg Stance balance test (OLS) and the force platform test (FPT) was tested for both the right and left leg. The test–retest reliability of DOLS was analysed using three measurements at least 2 h apart. The correlation between DOLS and FPT and between DOLS and OLS for blind subjects was −0.13 (n.s.) and 0.77 for the left leg and −0.78 and 0.89 for the right leg. For blindfolded subjects, the correlations were −0.56 (n.s.) and 0.93 for the left leg and −0.61 and 0.71 for the right leg. The weighted Kappa values for DOLS were between 0.47 and 0.88 for blind subjects and between 0.47 and 0.72 for blindfolded subjects. Based on these findings, DOLS appears to be a fairly valid and reliable balance test for subjects with vision loss, acquired and experimental. However, further tests of DOLS are necessary.

Previous studies show that people with intellectual disability (ID) appear to have impaired postural stability, a lower level of physical activity, and lower aerobic capacity compared to persons without ID, limitations that could affect their health. This study investigates these physical functions and their associations in a group of young people with ID compared to an age-matched group without ID. In total, this cross-sectional study included 106 high school students (16-20 years): 57 students with mild to moderate ID and 49 age-matched students without ID (control group). Tests were performed for postural stability, level of physical activity, and aerobic capacity. Both females and males with ID had significantly lower estimated maximum oxygen uptake (l O2/min) (p< 0.001 for females and p=0.004 for males) and a lower aerobic capacity expressed relative to body weight (ml O2/ kg*min) (p< 0.001 for females and p=0.012 for males) compared to age-matched peers. Analyses of associations were made using the Pearson’s correlation coefficient and multivariate linear regression analysis. No significant associations could be found. Physical status appears impaired for young people with ID and functions, such as postural stability, should be evaluated separately.

This study examines postural muscle responses to backward perturbations in young people (16-20 years) with and without intellectual disability (ID). The study included 56 young people with ID and 43 age-matched without ID volunteers. The subjects stood on a platform that was moved backwards in a surface translation. Lower and upper leg muscles and lower back spine muscles were recorded with surface electromyography (EMG). Muscle onset latency, time to peak amplitude (EMG), adaptation of muscle responses to repeated perturbations (using integrated EMG (IEMG) for epochs), and synergies and strategies were assessed. The result showed no differences between the two groups in muscle onset latency, synergies, and strategies. Young people with ID reduced their time to peak amplitude in investigated muscles, a response that was different from the group without ID. Also, young people with ID tended to adapt their IEMG less compared to the controls. These findings suggest that young people with ID have limited ability to use somatosensory information and adapt their postural muscle responses to repeated external perturbations.

OBJECTIVES:

Some studies have reported that people with intellectual disability may have reduced balance ability compared with the population in general. However, none of these studies involved adolescents, and the reliability and validity of balance tests in this population are not known. The purpose of this study was to examine the reliability of six different balance tests and to investigate their concurrent validity.

DESIGN:

Test-retest reliability assessment.

SETTINGS:

All subjects were recruited from a special school for people with intellectual disability in Bollnäs, Sweden.

PARTICIPANTS:

Eighty-nine adolescents (35 females and 54 males) with mild to moderate intellectual disability with a mean age of 18 years (range 16 to 20 years).

INTERVENTIONS:

All subjects followed the same test protocol on two occasions within an 11-day period.

MAIN OUTCOMES:

Balance test performances.

RESULTS:

Intraclass correlation coefficients greater than 0.80 were achieved for four of the balance tests: Extended Timed Up and Go Test, Modified Functional Reach Test, One-leg Stance Test and Force Platform Test. The smallest real differences ranged from 12% to 40%; less than 20% is considered to be low. Concurrent validity among these balance tests varied between no and low correlation.

CONCLUSION:

The results indicate that these tests could be used to evaluate changes in balance ability over time in people with mild to moderate intellectual disability. The low concurrent validity illustrates the importance of knowing more about the influence of various sensory subsystems that are significant for balance among adolescents with intellectual disability.

Syftet med denna studie var att undersöka vilka faktorer som till störst del påverkar tonårskillar till att sluta med tävlingsidrott, samt hur individuell kontra lagidrott, ålder och födelsekvartil påverkar beslutet. Studiens metod är kvantitativ enkät undersökning med tvärsnittsdesign, där enkäter bestående av fem bakgrundsfrågor och 16 delfrågor skickades ut till urvalsgruppen killar mellan 18-35 år som tävlat inom idrott men som i tonåren slutat. Enkäten utformades i Google Forms och delades med bekvämlighetsurval via länk på författarnas respektive Instagram och Facebook konton. Studien utgår från Leisure constraints theory och har därmed sin utgångspunkt i tre huvudsakliga begränsningsområden; intrapersonella begränsningar, interpersonella begränsningar och strukturella begränsningar. Vardera begränsningsområde har undersökts närmare genom enkäten, med hjälp av påståenden som uttryckt eventuella anledningar bakom avslutade tävlingskarriärer, vilket respondenterna fått ta ställning tillgenom likertskala och fritextsvar. Antalet respondenter i studien var 41 stycken och resultatet visade att interpersonella begränsningar var den kategori som påverkat respondenterna mest, specifikt att andra prioriteringar kommit före tävlingsidrotten. Strukturella begränsningar var den typ av begränsning som påverkat respondenterna minst. Intrapersonella begränsningar visade sig vara vanligare bland de respondentersom tävlat i individuell idrott jämfört med de som tävlat i lagidrott där för högkonkurrens i tävlingssammanhang visade sig vara den begränsning som var vanligast. Överlag visar studien relativt låga värden på samtliga begränsningsområden, vilket tyder på att det finns ytterligare faktorer bakom avslutade tävlingskarriärer blandtonårskillar som inte presenterats i denna studie. Dessutom skiljer sig studiens resultat delvis från tidigare forskning inom ämnet. Sammanfattningsvis går det att tolka resultatet som att beslutet grundas i individuella förutsättningar snarare än något specifikt begränsningsområde, vilket med hjälp av vidare forskning kan undersökas närmare.

Abstract Background In December 2019 the world saw the virus named Covid-19 for the first time. The virus caused many people around the world acute illness. The number of people who were in need of respiratory care increased sharply and so did the workload in the intensive care unit. Mars 11 2020, WHO declared the spread of the virus as a pandemic.

Aim To describe the intensive care and anesthesia nurse's experiences and management of ethical dilemmas in the care of patients with Covid-19.

Methods Qualitative approach with descriptive design and semi-structured interviews. The interviews were analyzed with qualitative content analysis. Five intensive care nurses and five anesthesia nurses who had worked with Covid-19 patients were included. 

Main Result The results of experiences of ethical dilemmas and management of Covid-19 patients is presented in five categories: Working with a new contagious disease, changed teamwork, condition changed for nursing, meet patients' dignity with feelings, manage ethical dilemmas. The categories show the specialist nurse's experiences and significance for the work situation.

Conclusion The Covid-19 pandemic has affected anesthesia and intensive care nurses and the work situation changed for many of them. This study emerged the ability of specialist nurses to adapt and meet a new infectious disease and a new need for nursing. It showed ethically and emotionally difficult situations in nursing that they had to perform to make longer progress and strategies for dealing with these.

Keywords Coronavirus, Covid-19, Ethical dilemmas, Intensive care, Pandemic, Specialist nurse's.

Aim

To describe the gardens and their use by individuals living at residential care facilities (RCFs) with high ratings on restorative values.

Background

Being outdoors has been described as important to older people's well‐being. Use of outdoor gardens may increase residents’ well‐being through experiences of restorative qualities such as being away and fascination. Thus far, there has been little research on restorative experiences of gardens in the care of older people.

Design

A descriptive design using behaviour mapping observations integrated with qualitative field notes and recorded conversations.

Methods

A criterion sampling of two gardens (out of a total of 87) was made based on residents’ ratings of restorative values; the two with the highest values were chosen. Eleven residents at the two RCFs took part. Data were collected through behaviour mapping observations, field notes and conversations on five occasions in the respective facilities during residents’ visits to the garden.

Results

The observations revealed that the main uses of the gardens were to socialise and relax. The conversations also showed that the garden stimulated residents’ senses and evoked memories from the past. These restorative values were interpreted as a sense of being away and fascination. Not having opportunities for outdoor visits was reported to result in disappointment and reduced well‐being.

Conclusions

The findings showed that two basic gardens with different characteristics and views could stimulate residents’ senses and evoke memories from the past; this supports the call for residents to be able to spend time in gardens to promote their well‐being.

Implications for practice

First‐line managers, nurses and healthcare staff in the care of older people should consider that regular opportunities to spend time outdoors may promote older people's well‐being through feelings of being away and fascination.

OBJECTIVES: To investigate the pathophysiological pathways leading to symptoms elicitation in multiple chemical sensitivity (MCS) by comparing gene expression in MCS participants and healthy controls before and after a chemical exposure optimised to cause symptoms among MCS participants.The first hypothesis was that unexposed and symptom-free MCS participants have similar gene expression patterns to controls and a second hypothesis that MCS participants can be separated from controls based on differential gene expression upon a controlled n-butanol exposure.

DESIGN: Participants were exposed to 3.7 ppm n-butanol while seated in a windowed exposure chamber for 60 min. A total of 26 genes involved in biochemical pathways found in the literature have been proposed to play a role in the pathogenesis of MCS and other functional somatic syndromes were selected. Expression levels were compared between MCS and controls before, within 15 min after being exposed to and 4 hours after the exposure.

SETTINGS: Participants suffering from MCS and healthy controls were recruited through advertisement at public places and in a local newspaper.

PARTICIPANTS: 36 participants who considered themselves sensitive were prescreened for eligibility. 18 sensitive persons fulfilling the criteria for MCS were enrolled together with 18 healthy controls.

OUTCOME MEASURES: 17 genes showed sufficient transcriptional level for analysis. Group comparisons were conducted for each gene at the 3 times points and for the computed area under the curve (AUC) expression levels.

RESULTS: MCS participants and controls displayed similar gene expression levels both at baseline and after the exposure and the computed AUC values were likewise comparable between the 2 groups. The intragroup variation in expression levels among MCS participants was noticeably greater than the controls.

CONCLUSIONS: MCS participants and controls have similar gene expression levels at baseline and it was not possible to separate MCS participants from controls based on gene expression measured after the exposure.

Purpose: To explore, understand and explain how an organization with hybrid working methods can create conditions for sustainable and health-promoting office work. Methods: Constructivist Grounded Theory was used for sampling and analysis of data from organizational documents and semi-structured interviews, conducted with eight employees, two managers and one HR-partner. Main results: A new theoretical model showing that organizations with hybrid working methods can create conditions for sustainable and health-promoting office work through individually designed working methods in constant change. Conditions are created through organizational clarity and a health-promoting hybrid culture, ensuring practical and social conditions, hybrid-adapted leadership, promotion of employee autonomy, flexibility and self-leadership. Conclusions: The needs and conditions of organizations and employees are constantly changing. To cope with these changes, the hybrid work needs to be individually adapted and the employees' autonomy and self-leadership strengthened. Organizations with hybrid working methods need to contribute with conditions which are presented in a new theoretical model and associated checklist. The checklist makes the results implementable in organizations, and thus contributes to the practical work environment management in organizations with hybrid working methods.

Purpose

We intended to assess consequences of reduced visual acuity for performance in a natural simple motor task (tracing) using objective kinematic performance measures. Specifically, we intended to elucidate the kind of relationship between the task performance and best corrected binocular visual acuity and to determine the threshold of visual acuity when task performance starts to deteriorate.

Methods

Ninety-five individuals with different best corrected visual acuity participated in the study (age 49 ± 12 years, mean ± SD, 27 men and 68 women). The participants manually traced maze-like visual patterns of different spatial complexity presented on the screen of a portable notebook computer using Clinical Kinematic Assessment Tool software. Tracing error was computed as performance measure in each trial with a spatial pattern matching technique – rigid point set registration method.

Results

The segmented linear regression analysis showed that the relation between visual acuity and tracing errors was best described with a regression function having a break point between two data segments. Tracing performance was unaffected by values of visual acuity below 0.2 on logMAR scale, but when logMAR values increased above this critical limit (i.e. when visual acuity is further reduced), tracing errors linearly increased. The rate of the increase of the tracing error correlated with the complexity of visual stimulus shape.

Conclusion

Testing of fine motor functions with objective kinematic measures during visuomotor tasks may help differentiating between actual effects of reduced visual acuity on eye–hand coordination in individuals with similar levels of impairment of visual acuity.

Currently, women comprise about ten percent of those sentenced to psychiatric forensic clinics in Sweden. Those who are sentenced to forensic care because of offending and violent behaviour have already taken a step away from the usually expected female behaviour. On the other hand, there are many women in forensic care who have not committed crimes, but who instead self-harm. Studies have identified a gender bias in diagnosing and care in psychiatric settings, but there are few studies conducted on women in forensic care. The present study therefore examined how the situation of women patients and female norms are expressed in the staff's talk about these women during verbal handovers and ward rounds at a forensic clinic in Sweden. The aim was to explore how psychiatric staff, in a context of verbal handovers and ward rounds, talk about women who have been committed to forensic psychiatric care, and what consequences this might have for the care of the patients. The content of speech was examined using audio recordings and a method of analysis that was inspired by thematic analysis. The analysis identified that the staff talked about the women in a way that indicates that they expected the women to follow the rules and take responsibility for their bodies in order to be regarded as acceptable patients.

According to the National Institute of Public Health about 350 000 Swedish children are living in homes where one or both adults has an alcohol addiction. Only one percent of these children is identified and offered support groups or similar activities, the rest goes by undetected through all of the educational years. The purpose of this study was to examine how the school nurse is working to identify children whose parents have an alcohol abuse and how they support these children. What support the school nurse wish to have in their work with these children, and how they keep themselves updated on the problems of these children. The basis of this study is based on a number of semi-structured questions. These questions were asked when interviewing ten school nurses. The material was analyzed by means of a qualitative content analysis. The results of the study demonstrate that the school nurse discovers children whose parents have an alcohol abuse by being watchful  and by gutfeeling in the meeting with the children and they are observent in the healthteam. They are giving support through personal contact with the children and by putting them in contact with

 other professions and buisnesses to provide them the support they need. The schoolnurse keeps her self updated of the problem through courses and lectures and by seeking information her self. The school nurse also cooperate with different professions round the school, and uses their own experiences from work and personal life.

Bakgrund: Sjuktalen har ökat till följd av psykisk ohälsa världen över. En av de främsta orsakerna till detta har varit den ökade förekomsten av stressrelaterad ohälsa och utmattningssyndrom. En grupp som har varit extra utsatt är personer i inom yrken i hälso- och sjukvården. Idag fokuseras det huvudsakligen på behandling och rehabilitering av utmattningssyndrom i forskning och praxis och det finns begränsad kunskap och initiativ kring primär- och sekundärprevention för utmattningssyndrom. Det är dock viktigt ur både ett individ- och samhällsperspektiv att förebygga utmattningssyndrom då utmattningssyndrom är ett allvarligt tillstånd som kan leda till stort lidande för individen och lång sjukfrånvaro från arbetslivet, vilket även är kostsamt för samhällsekonomin.

Syfte: Syftet med detta examensarbete var att undersöka skyddsfaktorer mot utmattningssyndrom hos personer inom yrken i hälso- och sjukvården.

Metod: En litteraturöversikt genomfördes och 12 vetenskapliga artiklar uppfyllde inklusion- och exklusionskriterierna och matchade forskningsfrågorna. Dessa lästes igenom. En tematisk analys av studiernas resultat genomfördes och resulterade i ett övergripande tema och fem underteman.

Resultat: Resultatet beskriver faktorer som skyddar mot utmattningssyndrom för personer inom yrken i hälso- och sjukvården. Exempel på dessa faktorer var vikten av autentisk och god arbetsmiljö, känsla av egenmakt och kontroll, deltagande i meningsfulla aktiviteter, återhämtning och praktiska tekniker som exempelvis mindfulness, yoga och bildterapi. Att få socialt stöd från närstående, kollegor och exempelvis kuratorer och präster var även en viktig faktor för att skydda mot utmattningssyndrom.

Slutsats: Skyddande faktorer för utmattningssyndrom finns på både individ-, organisations- och samhällsnivå och bör beaktas i utvecklingen av förebyggande insatser för utmattningssyndrom.

Människan i det samtida Sverige lever i en kultur som uppmanar till optimering och utvärdering av i stort sett allt hon gör, både i arbetslivet och privatlivet. Denna tidsanda tenderar att få oss att fokusera på ytan snarare än djupet och får förmodligen konsekvenser för vår människosyn och även hur vi ser på oss själva. Det verkar också som denna utveckling får negativa konsekvenser för människors hälsa och välbefinnande. Kan det till och med vara så att tidsandan förhindrar oss att växa och fördjupas som människor? I denna text diskuteras utmattning, gränssituationer och betydelsen av den kunskap som döljer sig bortom yta och optimering. Texten vill lyfta fram betydelsen av den kunskap som inte låter sig fångas i tabeller och skalor, den erfarenhetsbaserade kunskapen som döljer sig bortom de kunskapsgränser som vetenskapen ofta rör sig inom. Texten är tänkt att vara ett inlägg som skapar diskussion kring den samtida kulturens inverkan på människan och hennes livsupplevelse. Texten vill också bidra till reflektion kring den kunskapsdimension och kompetens som Människa-Kultur- Religionsprogrammet syftar att leda fram till och vad denna kunskap betyder i arbetet med människor. Innehållet berör både temat ’religion och kultur i svensk kontext’ och ’existentiell kultur’. Allt fler människor i Sverige idag hamnar i en situation där de inte längre klarar av att hantera sina liv. De befinner sig plötsligt i en situation där de inte kan arbeta, sköta sin familj, eller ens ta sig upp ur sängen. Det är kompetenta och ambitiösa människor som inte längre är kapabla att hantera sina liv. Vad är det som händer? Vad är det för mekanismer som bidrar till detta? I folkhälsopropositionen En förnyad folkhälsopolitik 177 (Prop. 2007/08, s. 110) ställs, nästan som i förbifarten, frågan om ”[…] upplevelsen av stress beror på att våra existentiella behov inte är tillgodosedda” (33). I min avhandling Vid utmattningens gräns (Eriksson 2016) är det den existentiella erfarenheten av utmattning som är i fokus. I den här artikeln vill jag relatera något av innehållet i avhandlingen till den aktuella samhällstrenden som säger att vi på alla livets områden måste jobba på optimering, att allt vi gör ska mätas, kontrolleras och därmed kvalitetssäkras. Kan det vara så att denna trend har motsatt effekt, att jakten på ständig förbättring istället för oss bort från ett arbetsliv, kanske till och med ett liv, med kvalité? Uppfattningarna hos patienter och vårdgivare i Vid utmattningens gräns är att det finns en gemensam nämnare hos många som drabbas av utmattning, en problematikens kärna som handlar om förändringar i tillvaron som skapar en distansering från det som genererar motivation och drivkraft i livet. Dessa förändringar leder i sin tur till en upplevelse av förlorad mening och livsdränering. Kanske kan detta vara en replik på folkhälsopropositionens fråga om det kan vara så att den ökande stressen i samhället kan ha att göra med att människors existentiella behov inte är tillfredsställda?

Verksamheten vid akademin för hälsa och arbetsliv utgör en kollegial och tvärvetenskaplig miljö som tar avstamp i människors olika livsvillkor och sammanhang med fokus på människan som individ, i grupper, organisationer och samhällen. Fysisk, psykisk och social hälsa utgör den gemensamma nämnaren. Utbildningen och forskningen kring dessa livsvillkor handlar om människors välbefinnande i en gynnsam ekologisk, ekonomisk och social miljö.

Rapporten är ett sätt för Akademin att ge en överblick över den forskning och de projekt som i stunden pågår. Sammanställningen i sig kan göra att forskare kan finna gemensamma nämnare och därigenom bidra till framtida projekt men också visa den intresserade externa forskaren vad för forskning och vilka forskningsprojekt som bedrivs vid Akademin.

Rapporten innehåller omkring ett hundratal projekt som svarar mot samhällsutmaningar inom hälsa och välfärd. Den kunskap som utvecklas genom vår forskning skapar goda förutsättningar för att vi ska kunna bidra till en positiv utveckling inom dessa områden. Ny kunskap kan göra skillnad!

Objective

The purpose of this study was to adapt and evaluate the psychometric properties of the ProFitMap-neck to Brazilian Portuguese.

Methods

The cross-cultural adaptation consisted of 5 stages, and 180 female patients with chronic neck pain participated in the study. A subsample (n = 30) answered the pretest, and another subsample (n = 100) answered the questionnaire a second time. Internal consistency, test-retest reliability, and construct validity (hypothesis testing and structural validity) were estimated. For construct validity, the scores of the questionnaire were correlated with the Neck Disability Index (NDI), and the Hospital Anxiety and Depression Scale (HADS), the Tampa Scale of Kinesiophobia (TSK), and the 36-item Short-Form Health Survey (SF-36).

Results

Internal consistency was determined by adequate Cronbach's α values (α > 0.70). Strong reliability was identified by high intraclass correlation coefficients (ICC > 0.75). Construct validity was identified by moderate and strong correlations of the Br-ProFitMap-neck with total NDI score (–0.56 < R < –0.71) and with the SF-36, HADS-anxiety, HADS-depression, and TSK (–0.32 < R < –0.82). Exploratory factor analysis revealed 2 factors for the Symptom scale: intensity index and the Function scale. Symptom scale–frequency index identified 1 factor. Structural validity was determined by percentage of cumulative variance >50%, Kaiser-Meyer-Olkin index > 0.50, eigenvalue > 1, and factor loadings > 0.2.

Conclusion

Br-ProFitMap-neck had adequate psychometric properties and can be used in clinical settings, as well as research, in patients with chronic neck pain.

The present study focuses on the parents of the first group of children in Sweden to receive a bone marrow transplant and survive. Its aim was to get in-depth knowledge of the parents' situation during this critical time. The result of 10 years of research (1988-98), the study deals with the situation to which the parents had to adapt and the strategies that they used to handle their situation within a long-term perspective. Two series of qualitative interviews with the parents of 20 children who had undergone bone marrow transplantation were carried out. A self-report questionnaire for coping was also used. The result shows that the child's illness and treatment played an important role in the parents' lives for many years. Those parents who managed to put reason before emotion rated their coping as better. A sense of participation was also a useful coping strategy.

A total of 52 children, age 9 or over and at least 3 years (median=8) beyond SCT for leukaemia (n=32) or nonmalignant diseases, participated in a single-centre study of health and quality of life (QoL). QoL and self-esteem were assessed with SCHQ-CF87, a generic multidimensional self-report instrument, and with 'I think I am'. As a group, the children had good QoL, but were below norm in the bodily pain (P<0.05), general health and self-esteem dimensions (P<0.01). Lansky or Karnofsky function levels were at a median of 90. Sense of coherence (SOC-13) was normal and correlated with SCHQ-CF87. Most children were subjectively and objectively in good health according to a self-assessment symptom inventory or by a medical record-based scoring of late effects, although pain was commonly reported. A total of 25% of the patients were rated as having moderate to severe late effects, without considering cataracts or infertility. Neither age at SCT, gender, malignant vs nonmalignant disease, nor stature influenced QoL significantly. Children with moderate to severe chronic graft-versus-host disease or cognitive deficits had lower QoL in some dimensions. No correlation was, however, found between the physician-rated total late effects score and overall QoL. Contrarily, QoL was clearly related to the degree of self-rated symptoms.

There is insufficient knowledge about the quality of life (QoL) among children after allogeneic stem cell transplantation (SCT). We recently reported an overall, good self-assessed QoL and health in 52 children who were three yr or more beyond SCT. The focus of this paper is the QoL as assessed by their parents, of whom 42 participated in the study. Using Swedish child health questionnaire (SCHQ)-PF50, parents rated their children's QoL lower on both the psychosocial (p<0.001) and physical summary scales (p<0.001) than the normative group of parents of children without chronic disease. Although essentially following each other, parent scores tended to be lower than children's own SCHQ-CF87 scores, particularly in the domains 'role socially due to physical limitations' (p<0.01) and 'self-esteem' (p<0.05). In the 'bodily pain' domain, patients' and parents' low scores agreed. The child's condition had a greater impact on parents' emotional situation than in the norm population (p<0.001). The severity of the child's physician-rated late effects (p<0.05) or of self-assessed subjective symptoms (p<0.01-0.05) was associated with a lower parental rating of the child's QoL. High Lansky or Karnofsky scores corresponded, respectively, to higher psychosocial (p<0.05) and physical (p<0.05) summary scores. It is concluded that as children, parents, and clinicians do not necessarily adopt similar views of a child's illness and of its impact on the child's life, clarity with regard to who is responsible for assessing the child's QoL is crucial when interpreting pediatric QoL studies.

OBJECTIVES:

Colorectal cancer (CRC) is suitable for population screening due to its high incidence and the recognizable and treatable prephase, and the present study is part of the larger study; Screening for Swedish Colons (SCREESCO). In Sweden, there is, to our knowledge, no questionnaire assessing shared decision making (SDM) with regard to CRC screening and, therefore, the aim of the study was to translate and culturally adapt the CRC screening module of the National Survey of Medical Decisions (DECISIONS) into a Swedish context.

MATERIAL AND METHODS:

A qualitative design inspired by guidelines based on methods for cross-cultural adaptation of questionnaires was used. In addition, focus group discussions, individual interviews and think-aloud (TA) sessions were performed.

RESULTS:

Of the 54 items included in the original DECISION survey, 32 were excluded, 22 were modified, and three were added as a result of the qualitative study. How the health care organization communicated and CRC screening knowledge was communicated were found to be the most important cultural differences between Sweden and the USA. The final questionnaire consists of 24 items.

CONCLUSION:

The process of translation and cultural adaptation of the CRC screening module of the DECISIONS survey resulted in the removal and modifying of a considerable number of items. The major rationale for the removal and modifying of items can be explained by the different cultural traditions between Sweden and the USA when communicating with the health care system regarding screening participation and how CRC screening information and knowledge is communicated.

Syftet med denna uppsats är att undersöka om lagförslag Ds 2008:18 kan innebära att Gävle Kommun, som har ett väl utvecklat anhörigstöd, kan komma att begränsas i sitt arbete i form av detaljstyrning.

Behovet av ett gott stöd för anhöriga har blivit alltmer uppenbart. Stöd till anhöriga är viktigt såväl ur den anhöriges som ur samhällets synpunkt. För anhöriga handlar det om att få stöd och känna uppskattning för de insatser de gör för en närstående. Det handlar om den anhöriges behov av vila och att få tid över för personliga angelägenheter men även om kunskaper och färdigheter för att kunna behärska situationen på bästa sätt. Med det nya lagförslaget Ds 2008:18 finns förväntningar om att underlätta för de som vårdar och sörjer för någon närstående. Den ger kommunerna som i dag endast har en lag som säger att kommunen bör erbjuda stöd till anhöriga istället en skyldighet att erbjuda stöd och hjälp. Vi formulerade en hypotes som menade att lagen kan leda till att kommuner med väl utvecklat anhörigstöd kan komma att begränsas eller ”styras” av nya bestämmelser. I Gävle kommun har man utarbetat ett väl fungerande anhörigstöd där man i dag arbetar utifrån ett individanpassat tänk med flexibla lösningar. Ingen lösning är bra för alla, menar personalen, och de utgår ifrån att alla människor är unika och har olika behov. Vi tror att lagen kan tillföra ramar och bestämmelser som kan leda till att detta individanpassade arbetssätt går förlorat.

Det vi kom fram till var att anhörigstödjarna i Gävle kommun känner en rädsla inför lagförslaget och de förändringar som det innebär. De tror att lagförslaget kommer att innebära förändringar i form av krav på dokumentation, krav på handläggning och förändringar i form av mindre valfrihet i arbetsutformningen. Politiker i omvårdnadsnämnden tror att lagförslaget kan komma att påverka stödet i de kommuner som har ett fungerande stöd i dagsläget och att det inte bara finns positiva effekter av lagförslaget. De anhöriga som vi intervjuat menar att de har svårt att se konsekvenserna av lagförslaget eftersom de inte har någon större inblick i anhörigstödets utformning.

Bakgrund: Arbetsmiljön för sjuksköterskor är ett ämne i tiden, detta eftersom sjuksköterskor idag påverkas i stort av ohälsosam stress. Många sjuksköterskor överväger att lämna yrket redan under det första yrkesverksamma året på grund av utmattning och bristande självkänsla. Syfte: Syftet med föreliggande litteraturstudie var att beskriva vilken arbetsrelaterad stress nyutexaminerade sjuksköterskor utsätts för under sitt första år som yrkesverksam samt beskriva de granskade artiklarna beträffande urval och undersökningsgrupp. Metod: En litteraturstudie på beskrivande nivå som baserats på 11 artiklar med både kvantitativ och kvalitativ ansats. Resultat: Den första tiden som yrkesverksam består av kaos och osäkerhet. Många nyutexaminerade sjuksköterskor betonar rädslan de lever med dagligen under arbetstid och den bristande tilltron på sig själv och sin kunskap inom området. Det finns svårigheter att delegera ut uppgifter på grund av rädsla för att förlora kontrollen. Den höga arbetsbelastningen kantas av tidsbrist och förväntningar från omgivningen om att alltid finnas till hands. Samtidigt bemöts de nyutexaminerade sjuksköterskorna med respektlöshet och bristande stöd från kollegor som orsakar frustration och arbetsrelaterad stress. Slutsats: Föreliggande studier visar att arbetsrelaterad stress är något nyutexaminerade sjuksköterskor utsätts för. Brist på introduktion och vägledning från erfarna kollegor resulterar i bland annat rädsla, osäkerhet i sin nya yrkesroll och frustration. Den höga arbetsbelastningen nyutexaminerade sjuksköterskor utsätts för består av tidsbrist, stort ansvar, låg personaltäthet och höga krav. Kollegor har ett stort ansvar att vägleda nyutexaminerade sjuksköterskor. Genom att stärka övergången till yrkesverksam sjuksköterska kan den första yrkesverksamma tiden som sjuksköterska stärkas. 

The aim of our study was to examine how integrity and self-determination is conceived by care assistants regarding older care takers with a problematic alcohol consumption, and if it affects their care provided. Qualitative semi-structured interviews, carried out with home care assistants (n=4) and analyzed hermeneutically with theories of power and discretion, showed that self-determination, as described by The Swedish National Board of Health and Welfare, is fulfilled only under certain conditions in the home care assistant’s interpretation. We also found a lack of guidelines and routines concerning problematic alcohol consumption among older care takers. Our results showed that home care assistants made individual assessments in their work with older care takers with problematic alcohol consumption actualizing a difficult ethical dilemma between neglect and paternalism. These ethical issues visualize power relationships where home care assistants have the prerogative to decide in relation to the care takers, where paternalism is a potential risk factor. Clear guidelines regarding the purchase of alcohol to older care takers with problematic alcohol consumption may contribute to home care assistants working more uniformly which leads to a higher state of legal security for the care takers.

Purpose of the study

The purpose of this study is to explore donor relatives’ experiences of the medical interventions enabling organ donation, as well as to examine the donor relatives’ attitudes towards donating their own organs, and whether or not their experiences have influenced their own inclination to donate.

Methods

The experiences of donor relatives were explored via in-depth interviews. The interviews covered every step from the deceased family member being struck by a severe bleeding in the brain till after the organ recovery, including the medical interventions enabling organ donation. The interviews were analysed through qualitative and quantitative content analysis.

Results

Brain death and organ donation proved to be hard to understand for many donor relatives. The prolonged interventions provided after death in order to enable organ donation misled some relatives to believe that their family member still was alive. In general, the understanding for what treatment aimed at saving the family member and what interventions aimed at maintaining organ viability was low. However, most donor relatives were either inspired to, or reinforced in their willingness to, donate their own organs after having experienced the loss of a family member who donated organs.

Conclusions

There is a need for greater transparency regarding the whole chain of events during the donation process. Yet, having experienced the donation process closely did not discourage the donor relatives from donating their own organs–but rather inspired a willingness to donate. This indicates an acceptance of the medical procedures necessary in order to enable organ donation after death.

Aim

To study whether the number of subordinates plays a role in first-line managers’ and subordinates’ ratings of empowerment, stress symptoms, and leadership–management performance. The aim was also to study relationships between managers’ empowerment and stress symptoms and leadership–management performance.

Methods

A longitudinal and correlational design was used. All first-line managers (n = 98) and their subordinates (n = 2085) working in the care of older adults in five municipalities were approached.

Results

With fewer (≤ 30) subordinates per manager, there were higher ratings of structural empowerment among managers and subordinates and lower stress symptoms among subordinates, than with ≥ 31 subordinates. Furthermore, structural empowerment was related to the managers’ stress symptoms and leadership–management performance, mediated through psychological empowerment. Moreover, structural empowerment can control/adjust for large numbers of subordinates in relation to stress symptoms.

Conclusion

The higher FLMs rated their access to empowerment, the lower stress symptoms and higher leadership–management performance they rated over time.

Overweight and obesity is a growing public health problem that increases the risks for development of illnesses like heart disease, diabetes and joint problems. This increase in overweight and obesity is also seen among children and studies have shown that obese children run a higher risk of contracting illnesses later in life. There are gains in prevention of overweight both for the individual and the society. School nurses are crucial in overweight and obesity prevention. The aim of this study was to describe school nurses´ preventive work against overweight and obesity among children in lower and upper primary school as well as perceptions and reflections on this work. Data was collected through semi-structured interviews wherein eight school nurses, municipally employed, participated.  The interviews were analyzed through qualitative content analyze The result revealed three categories: working methods in overweight and obesity prevention which comprises the work that school nurses perform alone and in cooperation with other professionals and parents; strategies in meetings with parents and children which comprises school nurses own strategies for prevention aimed towards parents and children and difficulties and limitations in preventive work that comprises barriers with in regards to time and resources, difficulties with parent communication and school values. School nurses preventive work is dependent on a good cooperation with school principals, teachers and least of all parents. Preventive work against overweight and obesity in children is a challenge that requires a school nurse's resources, time and knowledge. An extended cooperation with teachers might be an important strategy for the development of preventive activities.

BACKGROUND: Autonomy and participation are threatened within the group of older people living in nursing homes. Evidence suggests that healthcare personnel act on behalf of older people but are still excluding them from decision-making in everyday care.

OBJECTIVE: The purpose was to describe registered nurses' experience of caring for older people in nursing homes to promote autonomy and participation.

RESEARCH DESIGN: A descriptive design with a phenomenological approach was used. Data were collected by semi-structured individual interviews. Analysis was inspired by Giorgi's method. Participants and research context: A total of 13 registered nurses from 10 nursing homes participated. Ethical considerations: Ethical approval was obtained from the Regional Research Ethics Committee. Informed consent was achieved and confidentiality guaranteed.

FINDINGS: The essence of caring for older people in nursing homes to promote autonomy and participation consisted of registered nurses' awareness of older people's frailty and the impact of illness to support health and well-being, and awareness of acknowledgement in everyday life and trusting relationships. Paying attention to older people by being open to the persons' wishes were aspects that relied on registered nurses' trusting relationships with older people, their relatives and surrounding healthcare personnel. The awareness reflected challenges in caring to promote older people's right to autonomy and participation in nursing homes. Registered nurses' strategies, hopes for and/or concerns about development of everyday life in nursing homes were revealed and mirrored their engagement in caring for older people.

DISCUSSION AND CONCLUSION: Awareness of older people's frailty in nursing homes and the importance of maintained health and well-being were described as the main source for promoting autonomy and participation. Everyday life and care in nursing homes needs to be addressed from both older people's and healthcare personnel's perspectives, to promote autonomy and participation for residents in nursing homes.

Overweight is a growing problem and a threat against the public health. Children with overweight are at risk of remaining overweight as adults and therefore it is necessery to insert actions early. The aim of this study was to describe child health care (CHC) nurses and school nurses experiences and reflections of working with overweight children – to describe which strategies that were used from prevention to monitoring in this work and describe CHC- and school nurses interaction between them and with other health players. The study was conducted as a semi-structured interviewstudy with a descriptive design. A summon of eight child health care nurses and eight schoolnurses were interviewed. The material was analysed with a qualitative content analysis. The result showed the importance of parents participation to reach goals in weight control among overweight children. Children and parents with engagement facilitated the cooperation while a lack of insight made the cooperation more difficult. Overweight were considered as a sensitive topic and the nurses had a fear of upsetting the feelings of the familymembers. The nurses tried to customize their work to fit the individual needs of the overweight children. There were a lack of effective and uniform guidelines and the nurses wished for more resources, continuing education and expanded collaborations with other health players. The nurses in CHC and school health care services experienced their collaboration to be important but it was limited to over-reporting of the preschoolers. The conclusion of the study was that the participants experienced working with overweight children to be an important and difficult assignment. Their work rarely gave satisfactory results. The participants had their own ways of working and they lacked effective policy documents to follow which made them feel frustated and powerless. They wished for more time to work with overweight and better collaboration with other health players.

Karin Holmkvist (2014) Sleep, meals and physical activity among professional drivers during the day with work and spare time. Master’s thesis in health at work. University of Gävle.

Night work and irregular work hours affects social and biological rhythms in activity, eating, sleep and metabolism. Researchshows how theworking conditions andworking hours affect professional drivers´ lifestyle and there is a negative impact on their health. The aim of this cross sectional study was to describe and compare living rhythms of professional drivers. Six drivers participated. Three driver´s had daytime work and three driver´s had shiftwork. Self report data on work hours, sleep, sleep quality, meal and meal frequency was collected by either a smartphone application or a paper correspondent diary. During the same period physical activity was measured by an activity meter attached to the leg. The results show that drivers on averageslept7hoursno matter workdayor spare time (non significant).The results indicatethat driversfelt they hadagoodsleep quality.The resultshows thatdriverseat different types of meals like breakfast, lunch, dinner or having a coffee on workdays and on spear time.  The drivers have an averageof food intakes,2 times duringthe workingdayand2 times during spare time. The resultalso indicatesthat drivers eat fromthree food groups out ofseven. The results indicate that one meal achieved the plate model during work day and spear time. The drivers weremore sedentaryintheir absence(48 minutes /day)thanat work (34.5 minutes / day).Therewasno significant difference inphysical activitybetween workand spare time.

Conclusion: Drivers slept equal during workday or spare day. Food habits can be improved by increased frequency and distribution during twenty-four hours.The physical activity is on a acceptable level but can be improved. It can be done by workplace subsidizes training card or by motivating individual health consultations regarding diet and exercise habits.  This extension can lead to changes in professional operating environment such as education in diet and nutrition, sleep and physical activity.

Keywords: Professional driver´s, sleep, food, physical activity